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Dunand N, Seydoux M, Teixeira Magalhaes M, Bonsack C, Golay P, Spagnoli D, Pomini V. Supported employment coaches' difficulties and facilitators with clients diagnosed with personality versus other disorders: A qualitative study. Heliyon 2024; 10:e32955. [PMID: 38975130 PMCID: PMC11226893 DOI: 10.1016/j.heliyon.2024.e32955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/14/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Aim People with severe mental illnesses (SMI) face different occupational challenges than those diagnosed with personality disorders (PD). Supported employment (SE) has been validated for SMI patients but its effectiveness for individuals with PD remains unclear, and the reasons for this potential difference have not been explored. This study aimed to identify differences in SE practice for clients with SMI and those with PD. Methods Six SE job coaches were interviewed about their experiences. A thematic analysis was run. Results More difficulties and facilitators were mentioned regarding clients with PD than regarding clients with other SMI. For both, patients' symptoms were reported to negatively affect their (re)integration into the job market. However, in contrast to that of clients with SMI, the relation between symptoms and SE success for clients with PD involved difficult behaviors and their negative impact on the therapeutic relationship. Conclusion In summary, SE practice seems to be undermined by PD and could benefit from adaptations, such as specific training for SE teams to help them in managing clients with this disorder.
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Affiliation(s)
- Noëllie Dunand
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland
| | - Marine Seydoux
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland
| | | | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland
| | - Danièle Spagnoli
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentino Pomini
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Switzerland
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Culina I, Ranjbar S, Maillard P, Martin-Soelch C, Berney S, Kolly S, André J, Conus P, Kramer U. Symptom domains and psychosocial functioning in borderline personality disorder. Borderline Personal Disord Emot Dysregul 2024; 11:10. [PMID: 38835094 DOI: 10.1186/s40479-024-00255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is often characterized by severe functional impairment, even after a decrease in symptoms. A comprehensive understanding of psychosocial functioning in BPD is necessary to tailor treatment offer, which should address relevant aspects of daily life. The aims of the present study are to (1) conduct a cross-sectional comparison of functioning of a group with BPD and a non-BPD clinical comparison group at service entry, and to (2) assess the relationship between intensity of BPD symptom domains and psychosocial functioning. METHODS The sample consists of N = 65 participants with BPD and N = 57 participants from the clinical comparison group without BPD (non-BPD group). The Revised Borderline Follow-up Interview (BFI-R) was used to evaluate psychosocial functioning and the Revised Diagnostic Interview for Borderlines (DIB-R) to assess BPD symptoms. Linear, logistic, and multinomial regression models were run separately for each aspect of functioning as a function of BPD status or BPD symptom domains. RESULTS Only 23% of participants in the BPD group fulfilled criteria for good overall psychosocial functioning, compared to 53% in the non-BPD group. Furthermore, participants in the BPD group were less likely to have completed a high number of years of education, to work consistently, to be financially independent, to be in a cohabiting relationship and have a good relationship with parents. In addition, various links were identified between BPD symptom domains and functional impairments. CONCLUSIONS Consistent with prior research, the main impairments in functioning in the BPD group are found in the educational and vocational domains. Though some domains show impairment, others, like friendships, may act as potential resources. Further investigation on the relationships with symptom domains is required.
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Affiliation(s)
- Ines Culina
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | - Setareh Ranjbar
- Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Jérémie André
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- General Psychiatry Service, Department of Psychiatry, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Departement of Psychology, University of Windsor, Windsor, Canada
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Dunand N, Golay P, Bonsack C, Spagnoli D, Pomini V. Good psychiatric management for borderline personality disorder: A qualitative study of its implementation in a supported employment team. PLoS One 2024; 19:e0299514. [PMID: 38489261 PMCID: PMC10942029 DOI: 10.1371/journal.pone.0299514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION People with borderline personality disorder have difficulties with work. The Individual Placement and Support model has shown its worldwide effectiveness in terms of vocational rehabilitation for individuals with psychiatric disorders. However, only a few recent studies have explored its results for people with personality disorders, and the findings were mitigated. Additionally, Individual Placement and Support job coaches reported difficulties in supporting this population. An evidence-based psychotherapeutic method, also applicable in a case management context, called Good Psychiatric Management for borderline personality disorder, could potentially overcome these obstacles. This study aimed to evaluate the initial integration of Good Psychiatric Management in Individual Placement and Support practice. METHODS Individual Placement and Support practitioners of Lausanne University Hospital, Switzerland, were trained in Good Psychiatric Management in January 2022. Five of them participated in a focus group to collect their impressions about the training, and six were interviewed 9 months later to assess the initial adoption of Good Psychiatric Management into their practice. Thematic analyses were conducted. RESULTS Job coaches were positive about this new tool. All of them found it useful and beneficial both for them and their patients. They were able to follow the main Good Psychiatric Management principles in their practice However, the findings also suggested some additional improvements in the implementation process. CONCLUSIONS Integrating Good Psychiatric Management in Individual Placement and Support seems feasible, and the team who appreciated it adopted it. The method offers new perspectives in community support for people living with borderline personality disorder.
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Affiliation(s)
- Noëllie Dunand
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
- Department of Psychiatry, Community Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
- Department of Psychiatry, Community Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- Department of Psychiatry, Community Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Danièle Spagnoli
- Department of Psychiatry, Community Psychiatry Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Valentino Pomini
- Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
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Garikana S, Jain P, Megna JL, Leontieva L. Borderline Personality Disorder With Atypical Traits in a 30-Year-Old Female: A Case Report. Cureus 2024; 16:e55166. [PMID: 38558669 PMCID: PMC10980538 DOI: 10.7759/cureus.55166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
In this paper, we report an atypical presentation of borderline personality disorder (BPD) in a 30-year-old female with a history of childhood molestation and trauma and a prior diagnosis of post-traumatic stress disorder (PTSD). The patient was hospitalized due to anxiety, depression, and guilt over her relapse into alcohol use disorder. During her hospital stay, we diagnosed her with BPD based on psychiatric examination, clinical interviews, and patient history. While the patient exhibited some of the typical characteristics of BPD, such as an instability of interpersonal and romantic relationships, there were numerous findings that were atypical of BPD. These include a demonstration of mature defense mechanisms such as sublimation and altruism, high levels of occupational functioning, strong maternal caregiving behavior, and no history of self-harm. Further analysis of the patient's personality traits helped us identify that this presentation could be best characterized as a high-functioning internalizing subtype of BPD as identified in prior literature.
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Affiliation(s)
- Sarah Garikana
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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Kvarstein EH, Frøyhaug M, Pettersen MS, Carlsen S, Ekberg A, Fjermestad-Noll J, Ulvestad DA, Gikling EL, Hjermann E, Lindberget K, Omvik S, Eikenæs IUM, Hummelen B, Morken KTE, Wilberg T, Pedersen GAF. Improvement of personality functioning among people treated within personality disorder mental health services. A longitudinal, observational study. Front Psychiatry 2023; 14:1163347. [PMID: 37229394 PMCID: PMC10203961 DOI: 10.3389/fpsyt.2023.1163347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Objective Evidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment. Method An observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models. Results Thirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates. Conclusion Personality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.
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Affiliation(s)
- Elfrida H. Kvarstein
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mathias Frøyhaug
- Groruddalen District Psychiatric Center, Akershus University Hospital, Akershus, Norway
| | | | - Sara Carlsen
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Andreas Ekberg
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Department for Adult Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Jane Fjermestad-Noll
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Dag A. Ulvestad
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | | | - Eirik Hjermann
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Kenneth Lindberget
- Strømme District Psychiatric Center, Sørlandet Hospital, Kristiansand, Norway
| | - Siri Omvik
- Kronstad District Psychiatric Center, Haukeland University Hospital, Bergen, Norway
| | - Ingeborg U-M. Eikenæs
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Katharina T. E. Morken
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Theresa Wilberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Geir A. F. Pedersen
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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Serenko A. Personality disorders as a predictor of counterproductive knowledge behavior: the application of the Millon Clinical Multiaxial Inventory-IV. JOURNAL OF KNOWLEDGE MANAGEMENT 2023. [DOI: 10.1108/jkm-10-2021-0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose
This study investigates the role of personality disorders in the context of counterproductive knowledge behavior.
Design/methodology/approach
Data were collected through a survey administered to 120 full-time employees recruited from Amazon’s Mechanical Turk. Personality disorders were measured by means of the Millon Clinical Multiaxial Inventory-IV.
Findings
Personality disorders play an important role in the context of counterproductive knowledge behavior: employees suffering from various personality disorders are likely to hide knowledge from their fellow coworkers and engage in knowledge sabotage. Of particular importance are dependent, narcissistic and sadistic personality disorders as well as schizophrenic and delusional severe clinical syndromes. There is a need for a paradigm shift in terms of how the research community should portray those who engage in counterproductive knowledge behavior, reconsidering the underlying assumption that all of them act deliberately, consciously and rationally. Unexpectedly, most personality disorders do not facilitate knowledge hoarding.
Practical implications
Organizations should provide insurance coverage for the treatment of personality disorders, assist those seeking treatment, inform employees about the existence of personality disorders in the workplace and their impact on interemployee relationships, facilitate a stress-free work environment, remove social stigma that may be associated with personality disorders and, as a last resort, reassign workers suffering from extreme forms of personality disorders to tasks that require less interemployee interaction (instead of terminating them).
Originality/value
To the best of the authors’ knowledge, this work represents one of the first attempts to empirically investigate the notion of personality disorders in the context of knowledge management.
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Personality Pathology and Functional Impairment in Patients With Hypochondriasis. J Acad Consult Liaison Psychiatry 2023; 64:28-34. [PMID: 35964912 DOI: 10.1016/j.jaclp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/16/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research indicates substantial co-occurance of personality pathology and hypochondriasis, which both involve significant psychosocial impairment. OBJECTIVE This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity. METHODS Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instruments for personality pathology, health anxiety severity, and functional impairment (general, social, and physical): The Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Short Health Anxiety Inventory (SHAI), the 36-item Short Form health survey (SF-36), and the Global Assessment of Functioning (GAF). Hierarchical regression analyses were performed with boot-strapping (1000 samples). RESULTS Findings overall showed that personality pathology incrementally explained functional impairment over the influence of health anxiety severity. More specifically, findings revealed that the incremental effect of PID-5 trait dimensions was substantially larger than the SCID-II personality disorder criterion-count. Functional impairment was specifically associated with SCID-II symptoms of Avoidant Personality disorder and dependent personality disorder as well as PID-5 trait domains of negative affectivity, detachment, and psychoticism. CONCLUSIONS The findings highlight the potential significance of personality pathology for understanding and clinical management of functional impairment in patients with hypochondriasis. The personality features that best explained functional impairment were avoidant personality disorder and dependent personality disorder and, in particular, DSM-5 and the International Classification of Diseases, 11th revision personality trait domains of negative affectivity, detachment, and psychoticism.
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Edwards ER, Tran H, Wrobleski J, Rabhan Y, Yin J, Chiodi C, Goodman M, Geraci J. Prevalence of Personality Disorders Across Veteran Samples: A Meta-Analysis. J Pers Disord 2022; 36:339-358. [PMID: 35647770 DOI: 10.1521/pedi.2022.36.3.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite priorities around mental health, Veteran health care organizations have historically considered personality disorders to be preexisting conditions ineligible for disability benefits. However, growing evidence suggests potentially elevated prevalence of these disorders among military and Veteran samples and attests to implications of risk. The current study provides a meta-analytic review of literature on the prevalence of personality disorders in Veteran samples. Analysis of 27 unique samples, comprising 7,161 Veterans, suggests alarmingly high rates of Veteran personality disorders. Prevalence was highest for paranoid (23%) and borderline (21%) personality disorders and lowest for histrionic (0.8%) personality disorder. Rates were generally highest among Veterans experiencing substance use or elevated suicide risk and among studies establishing diagnoses through clinical interview (versus official medical record review). Results attest to the need for Veteran health care organizations to acknowledge personality disorders in this population, through both research and treatment, and to consider reclassifying personality disorders as potential "service-connected conditions."
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Affiliation(s)
- Emily R Edwards
- VISN 2 MIRECC, James J. Peters VA Medical Center, Bronx, New York
| | - Hannah Tran
- Teachers College, Columbia University, New York, New York
| | - Joseph Wrobleski
- VISN 2 MIRECC, James J. Peters VA Medical Center, Bronx, New York.,Teachers College, Columbia University, New York, New York
| | | | - Justin Yin
- Teachers College, Columbia University, New York, New York
| | | | - Marianne Goodman
- VISN 2 MIRECC, James J. Peters VA Medical Center, Bronx, New York
| | - Joseph Geraci
- VISN 2 MIRECC, James J. Peters VA Medical Center, Bronx, New York.,Teachers College, Columbia University, New York, New York
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Gyasi RM, Peprah P, Abass K, Pokua Siaw L, Dodzi Ami Adjakloe Y, Kofi Garsonu E, Phillips DR. Loneliness and physical function impairment: Perceived health status as an effect modifier in community-dwelling older adults in Ghana. Prev Med Rep 2022; 26:101721. [PMID: 35141124 PMCID: PMC8814641 DOI: 10.1016/j.pmedr.2022.101721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/03/2022] [Accepted: 01/23/2022] [Indexed: 11/01/2022] Open
Abstract
Background Methods Results Conclusions
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10
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Juurlink TT, Lamers F, van Marle HJF, Zwinkels W, Spijkerman MA, Beekman ATF, Anema JR. Individual placement and support and employment in personality disorders: a registry based cohort study. BMC Psychiatry 2022; 22:188. [PMID: 35300624 PMCID: PMC8932290 DOI: 10.1186/s12888-022-03823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To explore the relative impact of Individual Placement and Support (IPS) in patients with personality disorders (PDs) as compared to patients with other mental disorders. METHODS Data from the Dutch Employee Insurance Agency of participants enrolled in a national IPS trajectory between 2008 and 2018 were linked to corresponding data on employment outcomes, diagnostic and sociodemographic information from Statistics Netherlands. This resulted in a sample of 335 participants with PDs who could be compared with 1073 participants with other mental disorders. RESULTS Participants with PD just as often found competitive employment as participants with other mental disorders (37.6% vs. 38.0%, ORadjusted = 0.97, 95% confidence interval (CI) 0.74 to 1.27). The median time to gaining employment for those gaining employment (37.9%) was 195.5 days (mean number of days 252.5) in the PD group and 178.5 days (mean number of days 234.6) in the other mental disorders group (HRadjusted = 0.95, 95% CI 0.77 to 1.18). Also, total number of hours paid for competitive employment did not differ significantly between groups (median hours 686.5 vs 781.5, IRRadjusted = 0.85 95% CI 0.69 to 1.05). CONCLUSIONS Based on this study, which includes the largest sample of patients with PDs in any published IPS study, IPS seems to result in an equal percentage of patients with PDs and other mental disorders, gaining and maintaining employment. Although future studies should determine whether PD-specific adaptations to IPS are useful, our findings indicate that IPS could be an effective way to increase employment outcomes in PDs. This is important because the enormous societal costs of PDs are largely driven by loss of economic productivity, and because clinical recovery in PDs is suggested to be enhanced when patients are employed.
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Affiliation(s)
- T. T. Juurlink
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - F. Lamers
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,GGZ in Geest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - H. J. F. van Marle
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands ,grid.484519.5Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - M. A. Spijkerman
- grid.491487.70000 0001 0725 5522UWV, Dutch Social Security Administration, Amsterdam, The Netherlands
| | - A. T. F. Beekman
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,GGZ in Geest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - J. R. Anema
- grid.12380.380000 0004 1754 9227Amsterdam UMC, Vrije Universiteit, Social Medicine, Amsterdam Public Health Research Institute, De Boelelaan, 1117 Amsterdam, The Netherlands
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McGowan NM, Saunders KEA. The Emerging Circadian Phenotype of Borderline Personality Disorder: Mechanisms, Opportunities and Future Directions. Curr Psychiatry Rep 2021; 23:30. [PMID: 33835306 PMCID: PMC8035096 DOI: 10.1007/s11920-021-01236-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW We review the recent evidence suggesting that circadian rhythm disturbance is a common unaddressed feature of borderline personality disorder (BPD); amelioration of which may confer substantial clinical benefit. We assess chronobiological BPD studies from a mechanistic and translational perspective and highlight opportunities for the future development of this hypothesis. RECENT FINDINGS The emerging circadian phenotype of BPD is characterised by a preponderance of comorbid circadian rhythm sleep-wake disorders, phase delayed and misaligned rest-activity patterns and attenuated amplitudes of usually well-characterised circadian rhythms. Such disturbances may exacerbate symptom severity, and specific maladaptive personality dimensions may produce a liability towards extremes in chronotype. Pilot studies suggest intervention may be beneficial, but development is limited. Endogenous and exogenous circadian rhythm disturbances appear to be common in BPD. The interface between psychiatry and chronobiology has led previously to novel efficacious strategies for the treatment of psychiatric disorders. We believe that better characterisation of the circadian phenotype in BPD will lead to a directed biological target for treatment in a condition where there is a regrettable paucity of accessible therapies.
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK
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12
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Romirowsky A, Zweig R, Glick Baker L, Sirey JA. The Relationship Between Maladaptive Personality and Social Role Impairment in Depressed Older Adults in Primary Care. Clin Gerontol 2021; 44:192-205. [PMID: 30362909 PMCID: PMC6486454 DOI: 10.1080/07317115.2018.1536687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Personality pathology is associated with impaired social functioning in adults, though further evidence is needed to examine the individual contributions of personality traits and processes to social functioning in depressed older adults. This study is a secondary analysis examining the relationship between maladaptive personality traits and processes and social role impairment in depressed older adults in primary care. Methods: Participants (N = 56) were 77% female and ranged in age between 55-89 (M = 66.82, SD = 8.75). Personality pathology was measured by maladaptive traits (NEO-FFI) and processes (Inventory of Interpersonal Problems; IIP-PD-15). Individual variable as well as combined predictive models of social role impairment were examined. Results: Higher neuroticism (β = 0.30, p < .05), lower agreeableness (β = -0.35 p < .001) and higher IIP-PD-15 (β = 0.28, p < .01) scores predicted greater impairment in social role functioning. A combined predictive model of neuroticism and IIP-PD-15 scores predicted unique variance in social role impairment (R2 = .71). Conclusion: These results link select personality traits and interpersonal processes to social role impairment, suggesting that these are indicators of personality pathology in older adults. Clinical Implications: These findings lend preliminary support for clinical screening of personality pathology in depressed older adults utilizing both personality trait and process measures.
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Affiliation(s)
| | - Richard Zweig
- Ferkauf Graduate School of Psychology, Yeshiva University
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Juurlink TT, Lamers F, van Marle HJF, Michon H, van Busschbach JT, Beekman ATF, Anema JR. Employment in Personality Disorders and the Effectiveness of Individual Placement and Support: Outcomes from a Secondary Data Analysis. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:255-262. [PMID: 31820219 PMCID: PMC7293674 DOI: 10.1007/s10926-019-09868-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80-4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD.
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Affiliation(s)
- T T Juurlink
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands.
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands.
| | - F Lamers
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands
| | - H J F van Marle
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands
| | - H Michon
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - J T van Busschbach
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - A T F Beekman
- Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ, Amsterdam, The Netherlands
| | - J R Anema
- Social Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Iqbal SZ, French-Rosas LN, Banu S, Han JY, Shah AA. Borderline Personality Disorder: Impact, Overlap, and Comorbidities. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20191206-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Cruitt PJ, Oltmanns TF. Unemployment and the Relationship between Borderline Personality Pathology and Health. JOURNAL OF RESEARCH IN PERSONALITY 2019; 82:103863. [PMID: 32863466 PMCID: PMC7448725 DOI: 10.1016/j.jrp.2019.103863] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Evidence suggests that employment may buffer against the negative health outcomes associated with borderline personality disorder (BPD). The purpose of the current analyses was to examine unemployment and the BPD-health relationship prospectively. Participants were 1,536 older adults in a longitudinal study of health and aging, with repeated measures of physical health, depressive symptoms, and life satisfaction. We measured BPD features using multiple sources at baseline, and used principal components analysis to obtain latent scores. Multilevel models indicated that unemployment experiences did not moderate the prospective relationship between BPD features and physical health or life satisfaction, but did strengthen the positive relationship between BPD features and depressive symptoms. These findings provide insight into mechanisms of recovery for individuals with BPD.
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Affiliation(s)
- Patrick J Cruitt
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO
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16
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Juurlink TT, Vukadin M, Stringer B, Westerman MJ, Lamers F, Anema JR, Beekman ATF, van Marle HJF. Barriers and facilitators to employment in borderline personality disorder: A qualitative study among patients, mental health practitioners and insurance physicians. PLoS One 2019; 14:e0220233. [PMID: 31335909 PMCID: PMC6650068 DOI: 10.1371/journal.pone.0220233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 07/11/2019] [Indexed: 12/02/2022] Open
Abstract
Background Borderline personality disorder (BPD) is associated with unemployment and impaired functioning. However, a comprehensive understanding of barriers and facilitators to employment from a multidisciplinary perspective is currently lacking. Therefore, the aim of this qualitative study was to explore barriers and facilitators in gaining and maintaining employment in BPD from the perspectives of patients, mental health practitioners (MHPs) and insurance physicians (IPs). Methods Fifteen semi-structured interviews were conducted in patients with BPD and two focus groups were carried out among MHPs (n = 7) and IPs (n = 6) following a thematic content analysis approach. Results All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment. Barriers to employment mainly related to characteristics of BPD, such as low self-image, difficulty posing personal boundaries, difficulty regulating emotions, and lack of structure. MHPs and IPs additionally mentioned externalization and overestimation of competencies on the part of patients. Enhancing emotion regulation and self-reflection by successful treatment was suggested as a facilitator to enhance employment. Increasing collaboration between mental health and vocational rehabilitation services, and increasing knowledge about BPD, were suggested to increase sustainable employment and decrease stigma. Conclusions The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. As a next step, supported employment strategies that follow patient preferences and integrate employment and mental health services, should be studied in the context of BPD.
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Affiliation(s)
- Trees T. Juurlink
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- * E-mail:
| | - Miljana Vukadin
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Barbara Stringer
- Centre for Consultation and Expertise (CCE), Utrecht, The Netherlands
| | - Marjan J. Westerman
- Department of Health Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Social Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- Department of Psychiatry, Division of GGZ inGeest Specialized Mental Health Care, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Articulation and testing of a personality-centred model of psychopathology: evidence from a longitudinal community study over 30 years. Eur Arch Psychiatry Clin Neurosci 2018; 268:443-454. [PMID: 28389890 DOI: 10.1007/s00406-017-0796-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Advances in psychopathological research advocate a personality-centred model of common mental disorders (CMD). We tested four hypotheses to test such a model. First, personality relates to critical life events; second, both personality and critical life events relate to CMD; third, interaction effects between personality and critical life events relate to CMD; fourth, neuroticism explains the majority of variance in psychopathology. We analysed data (n = 453) based on seven semi-structured interviews from a longitudinal epidemiologic cohort study over 30 years spanning years 1979 (age 20) to 2008 (age 50). CMD and critical life events were assessed seven times between 1979 and 2008 and personality domains of neuroticism, extraversion and aggressiveness in 1988 and 1993. Aggressiveness and neuroticism related to partnership rupture and job loss. Neuroticism related significantly to major depression, anxiety disorders, substance-use disorders (SUD) and severity of psychopathology. Both partnership rupture and job loss related to major depression and severity of psychopathology, but not to anxiety disorder or SUD. An interaction effect between neuroticism and partnership rupture pointed towards significantly increased SUD prevalence. All associations held when additionally adjusted for childhood adversity and familial socio-economic status. According to a pseudo-R 2, neuroticism explained 51% of total variance in severity of psychopathology over time, while all three personality domains along with both partnership rupture and job loss explained 59% of total variance. In conclusion, personality, especially neuroticism, relates consistently to repeated measures of psychopathology. These associations are independent of and more pervasive than the effects of partnership rupture and job loss. Partnership rupture in interaction with neuroticism may further increase the risk for SUD. We conclude that neuroticism is a fundamental aetiological factor for severe psychopathology, but further testing of this model in other longitudinal studies is required.
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Juurlink TT, ten Have M, Lamers F, van Marle HJF, Anema JR, de Graaf R, Beekman ATF. Borderline personality symptoms and work performance: a population-based survey. BMC Psychiatry 2018; 18:202. [PMID: 29914431 PMCID: PMC6006846 DOI: 10.1186/s12888-018-1777-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to elucidate the interplay between borderline personality symptoms and working conditions as a pathway for impaired work performance among workers in the general population. METHODS Cross-sectional data from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2) were used, including 3672 workers. Borderline personality symptoms were measured with the International Personality Disorder Examination (IPDE) questionnaire. Working conditions (decision latitude, psychological job demands, job security and co-worker support) were assessed with the Job Content Questionnaire (JCQ). Impaired work performance was assessed as total work loss days per month, defined as the sum of days of three types of impaired work performance (inability to work, cut-down to work, and diminished quality at work). These were assessed with the WHO Disability Assessment Schedule (WHO-DAS). Common mental disorders (CMD) were assessed with the Composite International Diagnostic Interview (CIDI). RESULTS Number of borderline personality symptoms was consistently associated with impaired work performance, even after controlling for type or number of adverse working conditions and co-occurrence of CMD. Borderline personality symptoms were associated with low decision latitude, job insecurity and low co-worker support. The relationship between borderline personality symptoms and work performance diminished slightly after controlling for type or number of working conditions. CONCLUSIONS The current study shows that having borderline personality symptoms is a unique determinant of work performance. This association seems partially explained through the impact of borderline personality symptoms on working conditions. Future studies are warranted to study causality and should aim at diminishing borderline personality symptoms and coping with working conditions.
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Affiliation(s)
- Trees T. Juurlink
- Department of Psychiatry, VU University Medical Centre, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Femke Lamers
- Department of Psychiatry, VU University Medical Centre, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Hein J. F. van Marle
- Department of Psychiatry, VU University Medical Centre, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Social Medicine, VU University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, The Netherlands
| | - Aartjan T. F. Beekman
- Department of Psychiatry, VU University Medical Centre, Amsterdam Public Health Research Institute, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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19
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de Jong K, Segaar J, Ingenhoven T, van Busschbach J, Timman R. Adverse Effects of Outcome Monitoring Feedback in Patients With Personality Disorders: A Randomized Controlled Trial in Day Treatment and Inpatient Settings. J Pers Disord 2018; 32:393-413. [PMID: 28594629 DOI: 10.1521/pedi_2017_31_297] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to evaluate the differential effect of outcome monitoring feedback to therapists and to patients on outcomes in cluster B, cluster C, and personality disorder not otherwise specified (PD-NOS) patients. Day treatment patients (n = 112) and inpatients (n = 94) were randomly assigned to a feedback to therapist (FbT), feedback to therapist and patient (FbTP), or no feedback (NFb) condition. Feedback was based on weekly administrations of the Outcome Questionnaire-45 (OQ-45). In cluster B and PD-NOS patients FbTP resulted in increased OQ-45 scores during the first 6 months of therapy for not on track (NOT) patients. In cluster C patients, no adverse effects of feedback were found. These results suggest that for certain personality disorder patient groups, providing feedback during treatment may not always be beneficial, although more research is needed to further assess these effects.
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Affiliation(s)
- Kim de Jong
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jaap Segaar
- GGZ Centraal, Expertise Centre for Personality Disorders
| | - Theo Ingenhoven
- Pro Persona, Center for Psychotherapy, Amersfoort, The Netherlands
| | - Jan van Busschbach
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.,De Viersprong Institute for Studies on Personality Disorders, Halsteren, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Cruitt PJ, Boudreaux MJ, Jackson JJ, Oltmanns TF. Borderline personality pathology and physical health: The role of employment. Personal Disord 2018; 9:73-80. [PMID: 27657166 PMCID: PMC5311027 DOI: 10.1037/per0000211] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (BPD) is associated with negative physical health outcomes. Clinical case studies suggest that employment status may buffer against the negative effects of BPD on physical health. The goal of the current study was to examine the interaction between BPD features and employment status in predicting subjective perceptions of physical health. We hypothesized that employment status would moderate the relationship between BPD features and physical health, such that individuals who are employed would exhibit a weaker negative relationship between BPD features and self- and informant ratings of physical health. We investigated this question using data from a community sample of 1,630 middle-aged to older adults participating in the St. Louis Personality and Aging Network, an ongoing study of personality, health, and aging. Results indicated that employment status and BPD features were significant predictors of both self- and informant ratings of physical health. Confirming our hypothesis, the interaction term contributed to a significant increase in the proportion of explained variance, suggesting that employment is associated with a weaker negative relationship between BPD features and physical health. These findings highlight the importance of examining occupational functioning in the long-term course of BPD and offer avenues for further research into moderators of the relationship between BPD features and physical health. (PsycINFO Database Record
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Affiliation(s)
- Patrick J Cruitt
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Michael J Boudreaux
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Joshua J Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | - Thomas F Oltmanns
- Department of Psychological and Brain Sciences, Washington University in St. Louis
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21
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Zhang TT, Huang YQ, Liu ZR, Chen HG. Distribution and Risk Factors of Disability Attributed to Personality Disorders: A National Cross-sectional Survey in China. Chin Med J (Engl) 2017; 129:1765-71. [PMID: 27453222 PMCID: PMC4976561 DOI: 10.4103/0366-6999.186649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Personality disorders can lead to some disability. However, little is known about the disability prevalence and function impairments. This study aimed to describe the disability prevalence attributed to personality disorders, its distribution, impairments of daily activities and social functions, and risk factors in China. Methods: Using a descriptive and analytic epidemiological method, data from the Second China National Sample Survey on Disability in 2006 were analyzed. The disability prevalence attributed to personality disorders, its distribution in different people and regions, and risk factors were statistically calculated. Results: Respondents included 1,909,205 adults. The disability prevalence rate attributed to personality disorders in China was 5.9/100,000. The disability rate attributed to personality disorders of males was higher than that of females (P = 0.012), while the rate of the unemployed was higher than that of the employed (P < 0.001). Furthermore, the rates of unmarried/divorced/widowed people and the illiterate population were higher than those of married and educated people (P < 0.001). Regarding the severity of disability attributable to personality disorders, mild disability accounted for a majority or 60% of the respondents. The data showed that disability mainly impaired respondents’ ability to engage in daily activities, get along with people, and participate in social situations. According to the case-control study, marriage, employment, and higher education were protective factors of disability. Conclusions: The prevalence of disability attributed to personality disorders is low in China and always leads to mild disability. The distribution of disability attributed to personality disorders also varies in the Chinese population.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Yue-Qin Huang
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Zhao-Rui Liu
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Hong-Guang Chen
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
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22
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Gamma A, Schleifer R, Warnke I, Ajdacic-Gross V, Rössler W, Angst J, Liebrenz M. Duration of Absence from Work Is Related to Psychopathology, Personality, and Sociodemographic Variables in a Longitudinal Cohort. Front Psychiatry 2017; 8:252. [PMID: 29238308 PMCID: PMC5712568 DOI: 10.3389/fpsyt.2017.00252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/09/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine, in a non-clinical sample, the association of psychopathology, personality, sociodemographic information, and psychosocial indicators of non-occupational functioning with the duration of absence from work in the past 12 months. METHOD A longitudinal community cohort of 591 adults from Switzerland was analyzed using multilevel ordered logistic regression, with several alternative models as robustness checks. Psychopathology was assessed using the total score (Global Severity Index) of the Symptom Check List-90 Revised. RESULTS The highest psychopathology levels were associated with absences of 3 or more week duration, largely independently of age. Extraversion and being divorced, widowed or separated also corresponded with longer absences from work in some analyses. No effect of sex was found. Most effects tested were not statistically significant and estimates showed large uncertainty. CONCLUSION Although tentative, our results suggest a possible influence of psychopathology on work participation. It may thus be desirable in insurance-medical appraisals of work ability to include instruments for measuring psychopathology.
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Affiliation(s)
- Alex Gamma
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Roman Schleifer
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Ingeborg Warnke
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
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Muschalla B, Fay D, Seemann A. Asking for work adjustments or initiating behavioural changes – what makes a ‘problematic co-worker’ score Brownie points? An experimental study on the reactions towards colleagues with a personality disorder. PSYCHOL HEALTH MED 2015; 21:856-62. [DOI: 10.1080/13548506.2015.1109671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hengartner MP, von Wyl A, Tanis T, Halmi W, Galynker I, Cohen LJ. Severity of personality disorders and domains of general personality dysfunction related to attachment. Personal Ment Health 2015; 9:195-207. [PMID: 26033749 DOI: 10.1002/pmh.1297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/27/2015] [Accepted: 04/29/2015] [Indexed: 02/02/2023]
Abstract
This is the first study to link attachment to both severity of total DSM-IV personality disorder (PD) traits and domains of general personality dysfunction, using a sample of 72 inpatients from New York City. We assessed a measure of global PD severity and the core domains of personality functioning using the severity indices of personality problems (SIPP-118). Attachment was measured with the experience in close relationships-revised (ECR-R) and the relationship style questionnaire (RSQ). Global PD severity correlated most strongly with attachment anxiety (r = 0.65). Regression of the SIPP-118 domains on attachment produced models that accounted for a substantial proportion of variance in those scales (R(2) ranging from 28.2 to 54.2%). SIPP-118 relational capacities were the strongest predictor of ECR-R avoidance (β = -0.88) and anxiety (β = -0.58), as well as RSQ secure (β = 0.53) and fearful (β = -0.65). In conclusion, insecure attachment strongly related to the severity of global PD traits and specifically to relational capacities, which are a higher-order domain of general personality dysfunction. These findings provide further evidence that interpersonal problems are at the core of PDs and that attachment could constitute an important mediator of the social dysfunction in persons with personality pathology.
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Affiliation(s)
- Michael P Hengartner
- School of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | - Agnes von Wyl
- School of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Zurich, Switzerland
| | - Thachell Tanis
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | | | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Lisa J Cohen
- Icahn School of Medicine, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
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25
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Quirk SE, El-Gabalawy R, Brennan SL, Bolton JM, Sareen J, Berk M, Chanen AM, Pasco JA, Williams LJ. Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. Soc Psychiatry Psychiatr Epidemiol 2015; 50:807-20. [PMID: 25314916 DOI: 10.1007/s00127-014-0974-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/06/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States. METHODS This study utilized pooled data (n = 34,653; ≥20 years) from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Physical conditions were based on self-reports of being diagnosed by a health professional. Unadjusted and adjusted logistic regressions examined the relationship between PDs and physical conditions. RESULTS After adjustment (sociodemographic factors, past-year mood, anxiety and substance use disorders), Clusters A, B and C PDs were each associated with physical conditions (all p ≤ 0.01). Of the individual PDs, schizoid, schizotypal, narcissistic, borderline and obsessive-compulsive PDs were associated with CVD (all p ≤ 0.01) among younger adults. Paranoid, antisocial, borderline and avoidant PDs and younger adults with schizoid, schizotypal and obsessive-compulsive PDs were each associated with arthritis (all p ≤ 0.01). Significant associations were seen between paranoid, schizoid and schizotypal PDs and diabetes (all p ≤ 0.01). Finally, schizotypal, antisocial, borderline and narcissistic PDs were associated with GI conditions (all p ≤ 0.01). CONCLUSIONS PDs were consistently associated with physical conditions. Investigation of PDs and their relationship with physical health outcomes warrant further research attention as these findings have important clinical implications.
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Affiliation(s)
- Shae E Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, C/-Barwon Health, Ryrie Street, PO 281, Geelong, VIC, 3220, Australia,
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Rössler W, Hengartner MP, Ajdacic-Gross V, Angst J. Predictors of burnout: results from a prospective community study. Eur Arch Psychiatry Clin Neurosci 2015; 265:19-25. [PMID: 24927954 DOI: 10.1007/s00406-014-0512-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 06/03/2014] [Indexed: 03/04/2023]
Abstract
The possible link between work strain and subsequent mental disorders has attracted public attention in many European countries. Burnout has become a favored concept within this context. Most burnout research has concentrated on various professional groups and less so on ordinary community samples. We analyzed the data collected from a 30-year community sample during seven measuring occasions, beginning in 1978. In the last assessment (2008), we included for the first time the Maslach Burnout Inventory (MBI). Making the diagnosis of a lifetime mental disorder a predictor for burnout required us to compile the cumulative prevalence rate over all seven occasions. We also evaluated various psycho-social predictors of burnout over the life cycle of our sample. Concurrent associations of the MBI with subscales from the SCL-90-R were also investigated. The relationship of burnout with several SCL-90-R subscales demonstrated that, in all dimensions, burnout is associated with significant psychopathology. Persons with a lifetime mood disorder, and especially those with a combination of mood and anxiety disorders, had a higher risk for subsequent burnout. Various partnership problems were another predictor for burnout. In conclusion, the role of mental disorder as an occupational illness remains controversial. Various forms of such disorders as well as some psycho-social predictors can predispose to burnout. By contrast, work-related predictors appear to be less important.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Militärstrasse 8, 8004, Zurich, Switzerland,
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27
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Hengartner MP, Cohen LJ, Rodgers S, Müller M, Rössler W, Ajdacic-Gross V. Association between childhood maltreatment and normal adult personality traits: exploration of an understudied field. J Pers Disord 2015; 29:1-14. [PMID: 24932873 DOI: 10.1521/pedi_2014_28_143] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assessed normal personality traits and childhood trauma in approximately 1170 subjects from a general population-based community sample. In bivariate analyses emotional abuse was most pervasively related to personality, showing significant detrimental associations with neuroticism, extraversion, openness, conscientiousness, and agreeableness. Neuroticism was significantly related to emotional abuse and neglect, physical abuse and neglect, and sexual abuse. Emotional abuse was related to neuroticism in men more profoundly than in women (β = 0.095). Adjusting for the covariance between childhood maltreatment variables, neuroticism was mainly related to emotional abuse (β = 0.193), extraversion to emotional neglect (β = -0.259), openness to emotional abuse (β = 0.175), conscientiousness to emotional abuse (β = -0.110), and agreeableness to emotional neglect (β = -0.153). The proportion of variance explained was highest in neuroticism (5.6%) and lowest in openness (1.9%) and conscientiousness (1.8%). These findings help to understand the complex association between childhood maltreatment and both normal and pathological personality.
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Hengartner MP. The Detrimental Impact of Maladaptive Personality on Public Mental Health: A Challenge for Psychiatric Practice. Front Psychiatry 2015; 6:87. [PMID: 26106335 PMCID: PMC4460874 DOI: 10.3389/fpsyt.2015.00087] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022] Open
Abstract
Experts in personality psychology and personality disorders have long emphasized the pervasive and persistent detrimental impact of maladaptive personality traits on mental health and functioning. However, in routine psychiatric practice, maladaptive personality is readily ignored and personality traits are seldom incorporated into clinical guidelines. The aim of this narrative review is to outline how pervasively personality influences public mental health and how personality thereby challenges common psychiatric practice. A comprehensive search and synthesis of the scientific literature demonstrates that maladaptive personality traits and personality disorders, in particular high neuroticism and negative affectivity, first, are risk factors for divorce, unemployment, and disability pensioning; second, relate to the prevalence, incidence, and co-occurrence of common mental disorders; third, impair functioning, symptom remission, and recovery in co-occurring common mental disorders; and fourth, predispose to treatment resistance, non-response and poor treatment outcome. In conclusion, maladaptive personality is not only involved in the development and course of mental disorders but also predisposes to chronicity and re-occurrence of psychopathology and reduces the efficacy of psychiatric treatments. The pernicious impact of maladaptive personality on mental health and functioning demands that careful assessment and thorough consideration of personality should be compulsory in psychiatric practice.
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Affiliation(s)
- Michael Pascal Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW) , Zurich , Switzerland
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29
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Østby KA, Czajkowski N, Knudsen GP, Ystrom E, Gjerde LC, Kendler KS, Ørstavik RE, Reichborn-Kjennerud T. Personality disorders are important risk factors for disability pensioning. Soc Psychiatry Psychiatr Epidemiol 2014; 49:2003-11. [PMID: 24791656 PMCID: PMC4218874 DOI: 10.1007/s00127-014-0878-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/14/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether personality disorders (PDs) are associated with increased risk of disability pensioning in young adults, independent of other common mental disorders. METHODS 2,770 young adults from the general population were assessed for PDs by the Structured Interview for DSM-IV Personality, and for common mental disorders by the Composite of International Diagnostic Interview. These data were linked to the Norwegian National Insurance Administration's recordings of disability benefits for a 10-year period. Logistic regression analyses were applied to investigate the association between PDs and disability pensioning. The analyses were conducted for three types of PD measures: categorical diagnoses (any PD), dimensional scores of individual PDs and higher order components retrieved by principal component analyses. RESULTS Having any PD was strongly associated with disability pensioning, regardless of disability diagnosis. The estimated odds ratio (OR) was substantially higher for PDs [OR 4.69 (95% confidence interval (CI) 2.6-8.5)] than for mood disorders [OR 1.3 (CI 0.7-2.3)] and anxiety disorders [OR 2.3 (CI 1.3-4.3)]. Measured dimensionally, all PD traits except antisocial traits were significantly associated with disability pensioning. After adjusting for co-occurring traits of other PDs, only schizoid, dependent and borderline PD traits showed a significant positive association with disability pension, while antisocial traits showed a significant negative association. The principal component analyses showed that negative affectivity, psychoticism, and detachment was associated with an increased risk of disability pensioning, while antagonism/disinhibition and obsessivity were not. CONCLUSIONS PDs are strongly associated with disability pensioning in young adults, and might be more important predictors of work disability than anxiety and depressive disorders. Certain aspects of pathologic personalities are particularly important predictors of disability.
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Affiliation(s)
- Kristian Amundsen Østby
- Department of Mental Health, Norwegian Institute of Public Health, Nydalen, Box 4404, 0403, Oslo, Norway,
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30
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Hengartner MP, De Fruyt F, Rodgers S, Müller M, Rössler W, Ajdacic-Gross V. An integrative examination of general personality dysfunction in a large community sample. Personal Ment Health 2014; 8:276-89. [PMID: 25044701 DOI: 10.1002/pmh.1263] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/21/2014] [Accepted: 05/29/2014] [Indexed: 12/13/2022]
Abstract
Recently, the severity of general personality dysfunction has gained broad interest in personality disorder (PD) research. We analysed data of 511 participants aged 20-41 years from a comprehensive psychiatric survey in the general population of Zurich, Switzerland. We added the trait-scores from all DSM-IV PDs, as assessed by a self-report questionnaire, to provide a measure of general personality dysfunction. Adjusting for the Big Five personality domains as a proxy for stylistic PD elements, this composite PD score exhibited strong associations with neuroticism and schizotypy. General personality dysfunction additionally revealed a moderate detrimental association with psychosocial functioning and a strong effect on coping resources, on heavy drinking and drug use and on most psychopathological syndromes. Of particular interest is the strong association with total psychopathological distress and co-occurrence of multiple disorders, suggesting that increasing PD severity relates to the degree of global impairment independent of specific PD traits. Discussed herein are implications for public mental health policies, classification, conceptualization and treatment of PDs.
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31
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Rogers J, Hengartner MP, Angst J, Ajdacic-Gross V, Rössler W. Associations with quality of life and the effect of psychopathology in a community study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1467-73. [PMID: 24549839 DOI: 10.1007/s00127-014-0841-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Quality of life (QoL) is considerably impaired in mental illness and especially in depression. In this study, we aimed to determine the demographic, personality-related and psychopathological associations with QoL. In addition, we studied how the associations with QoL differ depending on the burden of psychopathology. METHODS We used a longitudinal observational cohort study, enriched for high levels of psychopathology, to examine data for QoL when the subjects were 34-35. We conducted a hierarchical linear regression analysis to determine how sex, personality, sociodemographics, somatic symptoms and psychopathology affect QoL. RESULTS Once all the variables were included in the model, total psychopathology is strongly negatively associated with QoL, while mastery and income were shown to have positive associations with QoL. Sex, personality and somatic symptoms had no significant associations with QoL once the other variables had been introduced into the regression. Due to the outstanding association with psychopathology, we tested whether the relationship had any interaction with the other predictors, but none reached statistical significance. CONCLUSIONS The most important association with QoL is psychopathology, regardless of sex, personality, coping resources, sociodemographics or the extent somatic symptoms. The relationship holds across the other variables included and the results are, thus, widely applicable.
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Affiliation(s)
- Jonathan Rogers
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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C’de Baca J, Castillo DT, Mackaronis JE, Qualls C. Ethnic Differences in Personality Disorder Patterns among Women Veterans Diagnosed with PTSD. Behav Sci (Basel) 2014; 4:72-86. [PMID: 25379270 PMCID: PMC4219251 DOI: 10.3390/bs4010072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/01/2014] [Accepted: 02/24/2014] [Indexed: 11/16/2022] Open
Abstract
Personality Disorders (PDs) impair the ability to function socially and occupationally. PD prevalence rates among veterans who have also been diagnosed with posttraumatic stress disorder (PTSD) range from 45%–79%. This study examined ethnic differences in PDs assessed with the Millon Clinical Multiaxial Inventory-III in 260 non-Hispanic white (64%), Hispanic (27%), and African American (9%), mostly single, women veterans in treatment for PTSD. After adjusting for covariates including number and sexual-nature of trauma, findings revealed the adjusted odds ratio of having a cluster A PD was almost three times higher for African Americans (p = 0.046) then the other two ethnic groups, which may be driven by the paranoid PD scale and potentially reflects an adaptive response to racial discrimination. In cluster designation analysis, the odds were twice as high of having a cluster B PD with childhood trauma (p = 0.046), and a cluster C PD with sexual trauma (p = 0.004), demonstrating the significance of childhood and sexual trauma on long-term chronic personality patterns in women veterans. These results highlight the importance of using instruments with demonstrated diagnostic validity for minority populations.
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Affiliation(s)
- Janet C’de Baca
- New Mexico VA Health Care System, Albuquerque, New Mexico, 1501 San Pedro SE, Albuquerque, NM 87108, USA; E-Mails: (D.T.C.); (J.E.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-505-265-1711 (ext. 5856); Fax: +1-505-256-2819
| | - Diane T. Castillo
- New Mexico VA Health Care System, Albuquerque, New Mexico, 1501 San Pedro SE, Albuquerque, NM 87108, USA; E-Mails: (D.T.C.); (J.E.M.)
- Department of Psychiatry, School of Medicine, University of New Mexico, MSC 09 5030, 1 University of New Mexico, Albuquerque, NM 87131; USA
| | - Julia E. Mackaronis
- New Mexico VA Health Care System, Albuquerque, New Mexico, 1501 San Pedro SE, Albuquerque, NM 87108, USA; E-Mails: (D.T.C.); (J.E.M.)
- Department of Psychology, University of Utah, 380 South 1530 East, BEHS 502, Salt Lake City, UT 84112, USA
| | - Clifford Qualls
- Clinical and Translational Science Center (CTSC), University of New Mexico, MSC 09 5030, 1 University of New Mexico, Albuquerque, NM 87131, USA; E-Mail:
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